Do we know how to use corticosteroids in acute severe ulcerative colitis?

Area of Science:

• Gastroenterology
• Clinical Pharmacology
• Inflammatory Bowel Disease

Background:

• Corticosteroids remain the primary treatment for acute severe ulcerative colitis (ASUC).
• Established treatment regimens for drug, dose, and duration are lacking 57 years after initial reports.
• Newer treatments like ciclosporin and infliximab broaden options, but corticosteroid use needs optimization.

Purpose of the Study:

• To investigate current UK gastroenterology unit practices for managing ASUC.
• To identify variations in corticosteroid use for ASUC.
• To highlight the need for evidence-based guidelines on corticosteroid treatment for ASUC.

Main Methods:

• A questionnaire was distributed in January 2010 to members of the British Society of Gastroenterology's inflammatory bowel disease section.
• The survey focused on corticosteroid use in a typical ASUC patient.
• 102 responses were collected, representing over 50% of UK gastroenterology units.

Main Results:

• Significant variation in practice was observed among UK gastroenterology units.
• Over 70% of responders use intravenous hydrocortisone (400 mg/day) initially; others use methylprednisolone or dexamethasone.
• While all units use oral prednisolone (most starting at 40 mg/day) for step-down, there's no consensus on reduction regimens or duration, leading to a 2.6-fold variation in total exposure.

Conclusions:

• There is a lack of consensus on corticosteroid management for acute severe ulcerative colitis in the UK.
• Wide variations in prednisolone dosing and duration highlight the need for standardized evidence-based guidelines.
• A controlled study on prednisolone dose and duration is essential to minimize harm from undertreatment or overtreatment.